| BCBS California | Risk-Reducing Mastectomy | 2025-11-01 |
| BCBS California | Scintimammography and Gamma Imaging of the Breast and Axilla | 2025-11-01 |
| BCBS California | Small Bowel/Liver and Multivisceral Transplant | 2025-11-01 |
| BCBS California | Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation | 2025-11-01 |
| BCBS California | Uterus Transplantation for Absolute Uterine Factor Infertility | 2025-11-01 |
| BCBS California | Virtual Colonoscopy/Computed Tomography Colonography | 2025-11-01 |
| BCBS California | Whole Body Dual X-Ray Absorptiometry to Determine Body Composition | 2025-11-01 |
| Health Net Comm & Medi-Cal Plan | Biofeedback | 2025-11-01 |
| Health Net Comm & Medi-Cal Plan | Burn Surgery | 2025-11-01 |
| Health Net Comm & Medi-Cal Plan | Genetic Testing for Preimplantation Genetic Testing | 2025-11-01 |